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Introduction Medical student clerkships are designed to provide students with an opportunity to develop a critical, problem-oriented approach to patient care. Given the time constraints of traditional medical student clerkships, it is not feasible during a short clinical rotation to expose students to all of the pathologic entities within a particular discipline. This is especially true at multiple, often distant clinical sites with varied patient populations. Methods To address this in Pediatrics, we created a series of web-supported case seminars to review a variety of common problems. The teaching cases for the core Pediatric Clerkship are based on the Council on Medical Student Education in Pediatrics Curriculum. Each case is organized to include case objectives, suggested references, a case presentation, and guiding questions. Students prepare for teaching sessions by reviewing the case's objectives, patient presentation, and guiding questions on-line. Seminar sessions use these cases for the review of the clinical approach to patients, organization of data, generation of a differential diagnosis, and management for a variety of pediatric conditions. Sessions are entirely small-group, interactive, and case-based. The curriculum is web-supported and uses multimedia resources to ensure that the cases are standardized and can be delivered efficiently across multiple and distant clinical sites. Results Their quality and presentation have been assessed using anonymous, written evaluations by each student. Responses to this method of teaching have been extremely positive. Students have reported that the teaching is of high caliber and that the topics are high yield. They were also impressed by both the format and the level of interactivity of the sessions. Discussion The cases have now been used as the primary teaching tool in the Pediatric Clerkship for four years. They are continually being refined to incorporate contemporary medical topics and further address LCME mandates.

Background and aims Isolated intestinal transplantation has been limited by poor patient and graft survival. If high survival could be achieved and if parenteral nutrition-associated liver disease were reversible, this procedure could be more widely applied, with early liver dysfunction indicating the need for transplant evaluation. Methods Twenty-six patients who had failed parenteral nutrition received 28 isolated intestinal transplants. We analyzed patient and graft survival, the effect of sirolimus on the severity and frequency of rejection, and the reversibility of liver dysfunction after transplant. Results Three-year actuarial patient and primary graft survival were 88% and 71%, respectively. Two patients underwent successful retransplants. Twenty-two patients are alive at a mean of 21+/-15 (median 18; range 3-51) months. Actuarial survival with freedom from parenteral support is 81% at 3 years (21 of 26 patients). Actuarial freedom from parenteral support among survivors is 95.5% at 3 years (21 of 22 patients). Early rejection was less frequent with sirolimus (34% vs. 70% without sirolimus) (P=0.007). Moderate and severe rejection was less frequent with sirolimus (1/11 episodes vs. 9/17 episodes without sirolimus) (P=0.05). No grafts were lost after introduction of sirolimus. In all four patients with advanced liver dysfunction, fibrosis and cholestasis regressed within 1 year. Conclusions High patient survival and parenteral nutrition-free survival can be achieved after isolated intestinal transplantation. Sirolimus treatment has eliminated graft loss. Parenteral nutrition-associated liver disease is reversible with intestinal transplantation. Refractory liver dysfunction in patients receiving parenteral nutrition should prompt consideration for isolated intestinal transplantation.